Welcome to the IPVC 2023 Conference Program Scheduling
The meeting will officially run on Washington DC, USA Time (EDT)
To convert the meeting times to your local time click here
The sessions can be viewed through the IPVC Virtual Platform. You can scroll through the program to the right using the arrows on the left side of the calendar.
HIGH-GRADE CERVICAL LESIONS AT START OF SCREENING AGE IN DANISH WOMEN HPV-VACCINATED AS GIRLS
Abstract
Introduction
In Denmark, three-yearly cytology screening starts at age 23, and follow-up depends on cytology outcome. HPV-vaccination began in 2008. Optimal screening strategy for women HPV-vaccinated as girls is not straightforward, as these women have lower cervical cancer risk than previous generations. Our study (Trial 23) provides knowledge on the first screening outcome in women HPV-vaccinated as girls.
Methods
Trial23 is a method study embedded in the nationwide screening program. It included women born in 1994, living in half of the regions in Denmark, and that attended their first screening. We recruited women screened from 1 February 2017-2 July 2021. Following national guidelines, all screened women had routine cytology and clinical management was based on this test only. For a randomly selected 50% of women, their samples were also HPV-tested. Follow-up diagnosis was most severe histology/cytology outcome between baseline screening date and 795 days later. Data were retrieved from the Danish Pathology Register.
Results
In total, 11,892 women were screened. Vaccination coverage was 92%. Among the 6021 HPV-tested women, 35% were HPV-positive, of which 16 and/or 18 accounted for only 0.8%. In women, that were cytology positive/HPV-positive (Cyt+/HPV+), 610 women had been followed up, and 138 had cervical intraepithelial neoplasia (CIN)2+ diagnosed; in women Cyt+/HPV- numbers were 76 and 5, and in women Cyt-/HPV+ 182 and 8. For double positive women, Cyt+/HPV+, 4.4 women were followed up per detected CIN2+; for Cyt+/HPV- it was 15.2; and for Cyt-/HPV+ it was 22.8. For CIN3+, numbers were 8.6; 76.0; and 45.5, respectively.
Conclusions
In Danish women, HPV-vaccinated as girls and Cyt+/HPV+ at first screen around age 23, a follow-up of four women were needed to detect one CIN2+ case and nine women for one CIN3+ case. Numbers were considerably higher for women with Cyt+/HPV- and Cyt-/HPV+, suggesting that immediate follow-up should be focussed on double positive women.
EFFECT OF SOCIAL MARKETING ON PAP SMEAR UPTAKE AMONG WOMEN RESIDING IN AN URBAN SLUM IN LAGOS, NIGERIA.
Abstract
Introduction
Globally, Nigeria is rated tenth in cervical cancer mortality. Uptake of cervical cancer screening is very low across various settings in Nigeria, especially among women residing in low resource settings. Social marketing principles can be used to design and implement interventions to promote behavior change including the practice of cervical cancer screening. This study assessed the effect of a social marketing intervention on uptake of Pap smear among women residing in an urban slum in Lagos, Nigeria.
Methods
This was a quasi-experimental study. The intervention arm consisted of 140 women from Ago-Egun Bariga community and the control arm consisted of 175 women from Oto-Ilogbo extension community. Social marketing intervention was instituted in the intervention group, applying 7 benchmarks of social marketing (Customer orientation, Behavioural focus, Exchange, Developing insight, Competition analysis, Theory, and Methods Mix) and guided by a qualitative enquiry. Data analysis was done using IBM SPSS Statistics version 20. Between groups comparisons and within groups comparisons were done using bivariate analysis with Chi-square, Students t-test and Paired t-test as appropriate.
Results
In the intervention group, the mean knowledge score of cervical cancer increased from 0.0 ± 0.3 at baseline to 15.1 ± 3.7 post-intervention (p < 0.001) and the mean attitude score of cervical cancer increased from 27.1±0.8 at baseline to 36.5±4.8 post-intervention (p < 0.001). There was a significant increase in uptake of Pap smear from 0.0% at baseline to 84.3%, post-intervention in the intervention group (p < 0.001). There was no statistically significant change in knowledge, attitude, or uptake of Pap smear in the control group.
Conclusions
Social marketing intervention can be successful in improving the uptake of Pap smear, even in settings where these are abysmally low. It is recommended that social marketing intervention be employed as a strategy for improving cervical cancer screening among women residing in slums.
SCALING-UP HPV TESTING FOR CERVICAL CANCER SCREENING IN WLHIV IN ZAMBIA
Abstract
Introduction
Zambia has an estimated cervical cancer (CaCx) incidence rate of 66.4/100,0000. CaCx remains the most common cancer accounting for nearly 25% of all cancers diagnosed and causing more cancer deaths in Zambia. The Ministry of Health (MOH) established the national CaCx screening program in 2006 using Visual Inspection with Acetic Acid (VIA) enhanced with digital cervicography. Recently, WHO made a call to eliminate CaCx through the 90-70-90 approach. The 70 target demands that 70% of eligible women are screened with a high-precision test at 35 and 45 years of age. We present Zambia's progress in scaling-up HPV testing for CaCx screening in WLHIV.
Methods
Through PEPFAR funding, the Ministry of Health procured HPV test kits which were distributed across the country in 2021. Through the support of Hologic, we held a country-wide orientation in September 2021 to improve the uptake of HPV testing for CaCx screening in WLHIV.
Results
A team of 24 facilitators, distributed across 8 of the 10 Zambian provinces trained a total of 133 health care workers. This included 38 staff from the laboratory, 82 nurse providers, and 13 medical doctors. The orientation included the basics of CaCx and available screening methods and why the country was moving towards HPV testing. Other key topics included sample collection, courier systems, and testing on the Hologic Panther and other platforms. This orientation showed an immediate increase in the utilization of HPV testing from a monthly average of 641 to 4,081 before and after the training, respectively. The overall HPV positivity rate was 32% (6,966/21,451).
Conclusions
These orientations are expected to improve the utilization of HPV testing for CaCx screening. Support from PEPFAR and HPV testing kits manufacturers such as Hologic is key in the integration of HPV testing in Low- and Middle-Income Countries.
DETERMINANTS OF INTENTION-TO-ATTEND AND CONFIRMED ATTENDANCE FOR CERVICAL SCREENING DURING COVID-19 PANDEMIC
Abstract
Introduction
The COVID-19 pandemic impacted participation in Australia’s primary HPV-based cervical screening program. We aimed to ascertain factors associated with intention-to-attend and attendance during the pandemic.
Methods
We used data from Compass-PLUS, an ongoing sub-study of the Compass large-scale randomised controlled trial of HPV vs cytology screening predominantly conducted in the state of Victoria, Australia. Compass-PLUS focuses on psychosocial aspects and women are invited to participate after receiving an invitation to attend their Compass 5-year exit test. We analysed data from an on-line survey at Compass-PLUS recruitment (Aug’20-Mar’22) and attendance data (Aug’20-Aug’22) for women randomised to HPV screening. We investigated associations between intention-to-attend and attendance, and i) socio-demographics, ii) mean anxiety-related scores and iii) agreement with statements on other factors (e.g. screening importance, social distancing, workload).
Results
Among 3,244 participants aged 26-75 years included, there was low agreement between intention-to-attend and confirmed attendance (Kappa=0.06). Women with a cancer family history and women residing in the least populous Australian states/territories were more likely to report intention-to-screen (p<0.05), but not to attend. Women more likely to attend were; aged 40+ compared to aged 26-39 (p<0.001), and part-time employed/retired compared to full-time employed [Relative risk (RR):1.07, 95%CI1.02-1.13; RR:1.10, 95%CI 1.02-1.18; respectively]. Attendance was found to be unrelated to mean pandemic anxiety score, COVID-19 influence on screening intention or recent anxiety scores. However, attendance was significantly associated with increased agreement with statements indicating difficulty attending due to increased workload (ptrend<0.003) and de-prioritisation of cervical screening (ptrend<0.001). Decreased attendance rates during the study were also observed in Melbourne residents who experienced extended lockdowns (Fig.1).
Conclusions
Cervical screening attendance was associated with older age and part-time employment/retirement but not anxiety scores. Increased workloads and reduced priority of cervical screening during the pandemic, and annual attendance cycles, may partly explain decreasing screening attendance rates during the study.
HEAD-TO-HEAD COMPARISON OF 7 HIGH-SENSITIVE HUMAN PAPILLOMAVIRUS NUCLEIC ACID DETECTION TECHNOLOGIES WITH SPF10 LIPA-25 SYSTEM
Abstract
Introduction
To evaluate the effects of type-specific preventive or therapeutic vaccination in population, sensitive and specific HPV genotyping methods are critical for the selection and monitoring of study subjects. The SPF10 LiPA-25 system of human papillomavirus (HPV) detection with high analytical performance was widely used in HPV vaccine clinic trials. In view of more valent HPV vaccines to be developed and evaluated, other comparable methods with simpler operation could be needed.
Methods
The performance of the LiPA-25 against that of other 7 assays, including 4 systems based on reverse hybridization (Bohui-24, Yaneng-23, Tellgen-27 and Hybribio-16) and 3 real-time PCR assays (Hybribio-23, Bioperfectus-21 and Sansure-26), was evaluated in selected 1726 cervical swab and 56 biopsy samples. A total of 15 HPV genotypes (HPV6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 66) were considered for comparison for each HPV type.
Results
Among the swab samples, compared with LiPA-25, compatible genotypes in 94.1% of samples for Hybribio-23, 92.8% for Yaneng-23, 92.6% for Bioperfectus-21, 92.4% for Hybribio-16, 91.3% for Sansure-26, 89.7% for Bohui-24 and 88.0% for Tellgen-27. The highest overall agreement of 15 HPV genotypes-combined was also Hybribio-23 (k = 0.879, McNemar’s test: P = 0.136), followed closely by Hybribio-16 (k = 0.877, P < 0.001), Yaneng-23 (k = 0.871, P < 0.001), Bioperfectus-21 (k = 0.848, P < 0.001), Bohui-24 (k = 0.847, P < 0.001), Tellgen-27 (k=0.831, P < 0.001), and Sansure-26 (k = 0.826, P < 0.001). Additionally, these systems were also highly consistent with LiPA-25 on biopsy specimens (all k > 0.897).
Conclusions
The levels of agreement for detection of 15 HPV types between other 7 assays and LiPA-25 were all good, and the hybribio-23 was most comparable with LiPA-25. The testing operation of HPV genotyping should be also considered for vaccine and epidemiological studies.
CERVICAL CANCER SCREENING BY VISUAL INSPECTION AND HPV TESTING IN ESWATINI
Abstract
Introduction
Eswatini has the highest incidence of cervical cancer, where approximately 6.5% of women develop cervical cancer before 75 years of age, and 35% of women aged 15–49 years are affected by the human immuno-deficiency virus. In 2009, visual inspection with acetic acid followed by cryotherapy, was introduced into the Eswatini cervical cancer prevention programme. Therefore, the study aim was to establish cervical cancer screening using visual inspection and HPV testing in Eswatini.
Methods
We present screening results of 654 women attending VIA-and-cryotherapy who participated in a sexually transmitted infections prevalence study, at which samples for HPV DNA testing and liquid-based cytology (LBC) were also collected. VIA positives (VIA+) ineligible for cryotherapy, suspected cancers and women with high-grade squamous intraepithelial or worse lesions (HSIL+) on LBC were referred for diagnosis and treatment. Women with negative VIA who were HPV positive (HPV+) and those VIA+ treated with cryotherapy were recalled for another VIA one-year later.
Results
The positivity rates of VIA, HPV, atypical squamous cells of undetermined significance or worse cytology abnormalities (LBC ASCUS+) and low-grade squamous intraepithelial or worse lesions (LBC LSIL+) were 9.7%, 42.6%, 13.2% and 5.3%, respectively. HPV testing detected 29 of 31 LSIL+ (93.6%, 95%CI: 78.6–99.2) while VIA only detected 11 (35.6%, 95%CI: 19.2–54.6). The HIV prevalence was 43% (95%CI: 39.2–46.9). HIV positives were at increased risk of being VIA+ (age-adjusted odds ratio: 2.5, 95%CI: 1.5–4.3), HPV+ (3.7, 2.6–5.3) and having LSIL+ (16.3, 4.9–54.8). The ineligibility rates for cryotherapy were 38% (24 of 63 VIA+), and 46% among HIV positives (18 of 39 VIA+).
Conclusions
HPV testing was substantially more sensitive than VIA, thus, HPV followed by ablative treatment may be more effective. However, the high ineligibility for cryotherapy highlights the need for improving the assessment of eligibility, particularly in populations with high HIV prevalence.
SHOULD THE AGE RANGE OF THE DUTCH HPV SCREENING PROGRAMME BE BROADENED? A MODELLING STUDY
Abstract
Introduction
In the Netherlands, women are invited for HPV screening between the ages of 30 and 60 (screening at age 65 is conditional on a previous positive screen). However, an increase in cervical cancer incidence in women aged 25-40 years has been observed recently. Meanwhile HPV vaccinated cohorts are reaching the screening age of 30 in 2023. Moreover, increasing healthy life expectancy is an important consideration for screening in older age groups. Due to these developments the starting and ending ages of the HPV screening programmes should be reconsidered.
Methods
The microsimulation model MISCAN-Cervix was recalibrated using updated (increased) cervical cancer incidence data in birth cohorts 1978-1992. We used this model to calculate the cost-effectiveness of starting screening at 25 for partly-vaccinated cohorts (born in 2002-2006). Additionally, we considered screening all (unvaccinated) women in birth cohorts 1962-1992 until 65 years old. The switch from the current program to the alternative screening programs was made in 2027. For the triage in all screening strategies genotyping for HPV16/18 was used. Main outcome measures were life years (LYs) gained, QALYs gained, costs and referrals per 100,000 women simulated, compared to the current screening strategy from 2027 to end of life.
Results
The current programme prevents 337 cancers, results in 18,162 referrals and leads to 3,625 lifeyears gained. Screening at age 25 results in few extra cases prevented (+0.1%-0.7%) and LYs gained (+0.1%-0.4%), but more referrals (2.4%-7.1%), higher costs (+3.3%-8.0%) and lost QALYs (-3.3%-8.0%) (Figure 1, 2, 3). Screening at age 65 leads to 8.5% extra cancers prevented, +6.0% referrals, +5.0% LYs gained, -5.3% QALYs gained and +15.8% costs.
Conclusions
This modelling analysis has shown that with the current knowledge, it might be preferable to screen unvaccinated women at 65 years old, while it is not recommended to screen women in partly-vaccinated cohorts at age 25.
HPV E6/E7 ONCOPROTEINS TESTING FOR CERVICAL CANCER SCREENING IN SETTINGS WITH HIGH BURDEN OF CERVICAL CANCER
Abstract
Introduction
Overexpression of HPV oncoproteins E6 and E7 is necessary for HPV driven cervical carcinogenesis. Hence, these oncoproteins are promising disease-specific biomarkers. Here, we report the first assessment of the 8-HPV type OncoE6/E7 cervical prototype test (by Arbor Vita Corp.) in HPV-positive women and women living with HIV (WLWH).
Methods
8-HPV type OncoE6/E7 testing was done locally in 2 centres participating in a screen-triage-and-treat randomized-controlled trial. One centre in Senegal included HPV-positive/HIV-negative women and another centre in South Africa included HPV-positive WLWH, using GeneXpert for HPV testing. A feedback questionnaire was given to the laboratory technicians conducting the oncoprotein test. Results from oncoprotein testing were compared to that of GeneXpert; when multiple HPV or oncoprotein infection types were detected, a hierarchical model was applied. The oncoprotein test accuracy was also evaluated as triage in HPV-positive WLWH.
Results
Nine laboratory technicians were trained in person or online to perform the test (figure 1). Despite operators’ perceived concerns about the need for experienced laboratory technicians and time-consuming procedures, they reported the test as easy to execute (figure 2). In total, 241 HPV-positive samples were tested (43 HIV negative/198 WLWH). Although the negativity of oncoprotein reduced with severity of lesions, the test missed 17/30 CIN3+ cases. The test was positive for targeted types that were negative on HPV DNA in 3, 2, and 1 of negative/CIN1, CIN2 and CIN3+ women, respectively (table 1). Among HPV-positive WLWH, sensitivity of the oncoprotein test to detect CIN3+ was 44% (95%CI=25-65) and specificity was 89% (95%CI=83-93).
Conclusions
The OncoE6/E7 test proved to be easy to execute in resource limited settings, but the discrepancies with HPV DNA based test outcomes call for further refinements and investigations. Further evidence is needed to evaluate the role of the oncoproteins as triage, especially in screen-triage-and-treat approaches.
A RANDOMIZED TRIAL OF SINGLE-DOSE HPV VACCINATION EFFICACY AMONG YOUNG WOMEN: FINAL EFFICACY RESULTS
Abstract
Introduction
Single-dose HPV 16/18 vaccination efficacy (VE) of 97.5% at month 18 is comparable to multi-dose regimens at months 24-36. Data on single-dose durability over several years are needed.
Methods
We conducted a randomized, multicenter, double-blind, controlled, cross-over trial to estimate the efficacy of single-dose HPV vaccination at three study sites in Kenya. Healthy, 15- to 20-year-old women were randomly assigned (1:1:1) to single-dose bivalent (HPV 16/18), nonavalent (HPV 16/18/31/33/45/52/58/6/11), or control (meningococcal) vaccination. The modified intent-to-treat (mITT) HPV 16/18 and HPV 16/18/31/33/45/52/58 cohorts included HPV naïve participants (i.e., participants who tested negative for vaccine type-specific HPV DNA at enrollment and month three and HPV antibody negative at enrollment). During follow-up, clinicians collected cervical swabs every six months, which were tested for HPV DNA for endpoints. The outcome was incident persistent vaccine type-specific HPV infection. We analyzed VE up to the cross-over study visit at month 36.
Results
Between December 2018 and November 2019, we recruited and randomly assigned 2,275 participants to receive bivalent (n=760), nonavalent (n=758), or control (n=757) vaccine. From enrollment to January 2023, 2,061/2,275 (90.7%) randomized participants provided at least five swabs for HPV DNA testing before cross-over vaccination. The median follow-up up to cross-over was 35 months. Seventy-five incident persistent infections were detected in the HPV 16/18 mITT cohort: two in the bivalent group, one in the nonavalent group, and 72 in the control group; nonavalent VE was 98.8% (95%CI 91.3-99.8%, p=<0.0001); bivalent VE was 97.5% (95%CI 90.0-99.4%, p=<0.0001). Eighty-nine persistent infections were detected in the HPV 16/18/31/33/45/52/58 mITT cohort: five in the nonavalent group and 84 in the control group; nonavalent VE was 95.5% (95%CI 89.0-98.2%, p<0.0001). The rate of SAEs was 7.8-9.5% by group; none were vaccine-related.
Conclusions
In a randomized trial among young women with HPV exposure, single-dose HPV vaccination was highly efficacious (>95%) over three years.